Crossroads: Where the Paths of Nurse and Patient Meet

By CRNP Dennis Butler

This is the story of a nurse's career. It starts as a nursing assistant in psychiatry, where he becomes the best man at his patient's wedding and tracks through the war zone of the high-tech intensive care unit. He enters the world of the nurse practitioner and takes the reader along with one of the top stroke doctors in the world. The final cha

• Language: English
• Publisher: Quantum Discovery
• Release date: Jun 6, 2023
• ISBN: 9781960197528

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WHERE THE PATHS OF NURSE AND PATIENT MEET

DENNIS BUTLER, CRNP

Crossroads

Copyright © 2023 by Dennis Butler, CRNP

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author, except in the case of brief quotations embodied in critical reviews and certain other non-commercial uses permitted by copyright law.

ISBN

978-1-960197-51-1 (Paperback)

978-1-960197-52-8 (eBook)

978-1-960197-50-4 (Hardcover)

Dedication

This book is dedicated to Kim, Ashley, and Olivia

TABLE OF CONTENTS

Introduction

Part I

Chapter I

Chapter II

Chapter III

Chapter IV

Chapter V

Chapter VI

Part II:

Chapter VII

Chapter VIII

Chapter IX

Chapter X

Chapter XI

Part III:

Chapter XII

Chapter XIII

Chapter XIV

Chapter XV

Chapter XVI

Chapter XVII

Chapter XVIII

Chapter XIX

INTRODUCTION

Why did she call me? Why did she call me? She was one of the few patients who had my cell number. It was a beautiful Sunday afternoon, the backdrop to the pendulous motion of my little girl in her swing and her obvious delight. It was a Norman Rockwell moment until my phone rang and I was snatched into another world. The contrast could not have been greater. I watched the smiling face of my innocent child while listening to the desperation of a women telling me that she had decided to end her life. She wanted to thank me for what I had done for her before she left this world. Why did she call me? Why did she call me? I wasn’t prepared for this. I wasn’t trained to talk people down off a ledge yet here I was. Peggy was an older woman I had seen in clinic. Her problem had been difficult to control so I gave her my number. Now, she was barricaded in her bedroom with a gun. I could hear the voices of her daughter and a police officer pleading with her through the door. In only a minute, I had gone from playing delightfully with my little girl to being thrust into a situation where I was fighting to keep a woman from taking her life. I steeled myself against hearing the gunshot. So, how does this work on TV? What would Frazier say? He was good at handling people over the phone. What a crazy thought but what else was there for me to reference? This was out of my wheelhouse. I thought mo-mentarily that this was a conversation with a crazy person on each end of the line. I fumbled for a minute then realized I had better start talking and hope I said the right thing. I told her that she was taking a permanent so-lution to a temporary problem. I reminded her of how valuable she was to her family. I promised to get help for her but real life ain’t the movies. The hero always talks them down of the ledge. There is always a happy ending. Our ending came when Peggy decided to end our conversation. She said goodbye and hung up. Oh no! Oh no! Oh no! Was my patient about to be dead? Had I failed the woman who thought so much of me that she called me in what we both though were the last moments of her life? The hero had failed to save the day. Mighty Casey had struck out. Fortunately, I had managed to keep the crisis from intruding into my little girl’s sphere of happiness. She never detected my stress. We went inside and my wife talked me down off of my ledge. I had done everything I could do. The following morning, I went to work and shared the story with my doctor. Later that day, we learned that despite my shortcomings as a would-be Frazier, Peggy was still among the liv-ing. Thank you, God! I stopped and thought about it. One moment I am pushing my little girl in her swing and the next minute I am standing in my back yard trying to talk somebody out of killing themselves. I am not making this up. This really happened. How did I get here? That journey started a long, long time ago.

PART I

BOB: THE HEALING OF THE MIND

CHAPTER I

PSYCH 101

I never dreamed of being a nurse. I was an English major without a clue as to what I wanted to be. When my father started asking questions about post-graduation plans, I had no answer. I didn’t like to think or talk about it. Fortunately, my brother’s wife taught nursing at one of the state schools and told me her school would love to have me. I was working part-time in a drug store and really liked that environment. I wasn’t crazy about being a male nurse but figured nursing school was as good a place as any for me to discover what I wanted to do with my life. I was at a crossroads in my life, and I took the road less taken that led me to what I now believe is my true calling. I transferred schools to a new life.

The morning after my conversation with my father, I hurried about the business of transferring schools. This would be a great adventure. Jean, the girl I was so in love with, was making plans to go to the same school, and I would be living on my own and have a whole new life. On New Year’s Day, I packed my car and headed west to begin my new adventure.

It wasn’t too long before I discovered the financial disadvantage of not living at home. If I were to flourish, I needed a job. The logical place to look was in the hospital across the street from the dorm.

The hospital employment office was always glad to see male applicants who were sorely needed in orthopedics and psychiatry. Orthopedics involves patients who are immobile and require a great deal of lifting. Psych was easier work most of the time. On bad days, however, an out-of-control patient might have to be placed into restraints. It was always assumed that the men took the lead in these endeavors. Nevertheless, I took the job on the psychiatric unit.

Psychiatry is different than most other disciplines, because nurses are directly involved in therapy. Many times the nurse is the therapy. In psych, I would not be as restricted as a nursing student would be in most disciplines. I couldn’t give meds, but I could be therapeutic.

This psych unit was not designed for the violent patient. Most patients were there on a voluntary basis. The entrance to the unit was a large, wooden door with a wire-reinforced glass window. It was unlocked most of the time. The unit included a men’s hall that ended in the game room, and a women’s hall that ended in the solarium. The nurses’ station was located just inside the front door, where the two halls intersected. Across from the nurses’ station was a coffee room. Most socialization took place in the solarium or the coffee room.

The only intimidating part of the unit was a wing that included exam rooms, where ECT, Electro Convulsive Treatment, was sometimes used. Electro Convulsive Therapy or shock therapy has obtained a bad reputation, but very depressed patients seemed to benefit from it. Still, it was very rarely used. Another special room located on this floor was for patients who became violent or who were at high risk for suicide. The door looked the same as any other door in the unit. Fire code dictates that doors open into the room. This, however, can allow patients to barricade themselves in the room. Accordingly, a smaller door was cut out of the main door that opens out. This smaller door was always locked, and only the nurses had the keys. Inside, the room was very spare. There were no curtains or table lamps. In the bathroom, the mirror was stainless steel rather than glass, and was bolted to the wall. Even the light switch had to be operated with a key. Fortunately, this room was also rarely used.

Most of the patients here were depressed. Some had disorders such as obsessive-compulsive disorder, and occasionally we would see a case of manic depression. This provided a good introduction to psychiatry for the medical students at this teaching hospital, where they could develop interpersonal communication skills with patients sick enough to warrant care but still not be too terribly ill.

They used an interesting treatment called milieu therapy. The idea is to regulate patients’ behavior by the environment in which they reside. The standards of conduct among patients are highly structured. These patients have the capability of coming together and forming a community that is fairly normal socially. Accordingly, if another patient begins to act in a way that does not fit the established norm of the group, they can be chastised or ostracized by the group. In some patients, this spontaneous peer pressure can work extremely well.

I generally worked night shift where my job was mostly to be The Man, capable of restraining any patient that might become unruly in the middle of the night. Just knowing that there was a male on the unit was frequently enough to keep some patients in check. Aside from that, my job was to interact with the patients and report any significant findings. After the patients went to sleep, I would check on the men every hour to make sure they were all okay. The only hard part about this job was staying awake in the wee hours of the morning. About 4:00 AM was always brutal.

The people I met here were quite interesting—patients and staff. My favorite nurse was Cora. She was just a little older than I was. She was short, petite, pretty, and friendly. We would talk for hours.

Ingrid was an older woman on staff. She tolerated no nonsense, and could not be manipulated. One day, she was the author of one of the funniest Freudian slips I’ve ever heard. When I reported for work, she complained, We’ve had three admissions, and two discharges, and had patient government and group therapy. It’s been a mad house around here today. I nearly fell in the floor laughing. She cocked her head at me, clearly not understanding what I found so funny. Then she slowly smiled as she realized the irony of her remark.

The people here were as diverse as the general population. There were men and women, young and old, black and white. There weren’t too many rich people on the unit but a number of poor ones.

Learning to work with psychiatric patients was a little bit like going swimming at the beach. The ocean can look large and threatening; it is not something you want to rush headlong into without testing the waters. I followed a similar strategy. Most of my initial contact with the patients was across the hall from the nurses’ station in the coffee room. I would sit there and listen to the patients talk and try to stay out of things. One day, someone thought it would be a good idea for me to kiss the young woman next to me on the cheek. It might have been therapeutic for her, but that young woman was so unattractive, I just couldn’t bear to do it. You could get yourself into trouble in that coffee room.

Most of the first few weeks, I just hung out around the unit. I came and went and so did the patients. I talked with them, but it was just superficial chitchat. Each day on a nursing unit begins with the change-of-shift report, a time when the off-going nurses relate what has happened on their shift to the in-coming nurses. One day I heard about a new admission. It was a young man named Bob who had attempted suicide for the third time. He was depressed. I was stunned to find that the focus of his suicidal depression was his concern about how he would perform on his wedding night. What!? I reacted. Are you serious? Oh come on! I’ll have this guy straightened out in about two hours if you let me! He’s trying to commit suicide over THAT!? I had no idea what an incredibly complex, incredibly sad, incredibly dramatic situation simmered beneath the surface of this seemingly laughable notion.

Bob was a young man in his early twenties of slender build, with brown hair and piercing, pensive blue eyes. There was nothing especially unusual about him. He was quiet, but his hands did tremble just a bit. Being relatively fresh from a suicide attempt, he was on suicide watch. His room was searched for anything he might use to hurt himself, and someone had to look in on him at least once every hour wherever he happen to be, even through the night.

Like most new people in a group, Bob kept to the edge of things for the first few days and did not interact very much. I worked nights and most of what I knew about him I heard in report. My initial impression of him was that of a figure sleeping quietly under the covers. After a few weeks in relative isolation, he moved out of the back hall and into the male wing of patients. It didn’t take long before his relationship with me began to evolve. Most of the people on the unit were women, so there weren’t many people Bob could talk to about his problem. His psychiatrist, Dr. Trask, was male, as was Harry, the attendant who worked evenings. Nobody gave Harry any lip. He was a big black man in his thirties who stood about 6’ 5" tall. Harry was friendly, but not the kind of person who